NPI | 1841701422 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95012918) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95094023) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95012918) | |
Enumeration Date | 2017-10-23 |
Last Update Date | 2021-11-29 |